Overeating and Bipolar Disorder

When you think about co-occurring disorders associated with bipolar disorder, you generally think of drug or alcohol abuse. But there’s another one you should consider: eating disorders.

For example, binge eating is a problem that many people with bipolar experience. Both conditions typically begin at a fairly young age. Both are experienced in cyclical patterns. And both are associated with changes in energy levels and eating patterns.

There’s scientific evidence that the two conditions are related. For example, research has shown that 30% of people with bipolar disorder also have problems with binge eating, Binge Eating Disorder (BED), or bulimia, and more than 9% of people with BED also have bipolar disorder.

The two disorders are intertwined, affecting each other. Someone experiencing a manic episode may be likely to overeat or binge, probably because of impaired impulse control. Depression, on the other hand, may lead to decreased appetite and low energy that makes it difficult to prepare food.

That’s not always true, though. The revved-up feeling of mania can lead someone to skip meals. Depression can lead a person to eat more “comfort foods,” which are often laden with carbs and sugar, as a coping mechanism, however maladaptive. These foods may increase serotonin and so make the person feel better temporarily. Either way, the over/undereating can cause stress while shopping or preparing food, or result in dissatisfaction with body image.

Medication for bipolar disorder can also have an effect on eating behaviors. We all know that certain drugs cause weight gain as a side effect. Antipsychotics, for instance, may contribute to increased eating because of changes in the brain’s reward system and a decreased ability to tell when you are full. And weight gain may lead to cycles of bingeing and purging.

Research has also shown that people with co-occurring bipolar and an eating disorder also may have PTSD, indicating a possible link between the conditions. It’s thought that people who have experienced trauma may use eating as a control mechanism.

At any rate, the combination of the two disorders is complex, and it’s likely that a person with both conditions may need help from a team or a holistic approach to treatment, both psychological and medical. It’s been suggested that topiramate (Topamax) or lamotrigine (Lamictal) can be considered, as these mood stabilizers don’t appear to result in weight gain.

Personally, I had a combination of the comfort food eating/skipping meals cycle. When I was in college, my weight fluctuated from roughly normal to too thin. Since then, thinness has not been a problem, possibly because of the medication I take. I certainly have a desire for comfort foods like mashed potatoes, pasta, and large amounts of cheese. One of my crazier comfort foods has been ridged potato chips with cream cheese, topped with M&Ms. My husband knows that when I want those particular ingredients, I’m sliding into depression. Lately, I’ve been swinging between comfort foods and skipping meals. On the other hand, I’ve lost 18 pounds since the spring. (My doctor asked me how I did it and I replied, “Eating less” rather than “skipping meals.” He thought I meant portion control, which I do try to do.) My bipolar disorder, while mostly stable, is still a cause of (less extreme) mood swings. My eating habits are likely just that — habits that I need to break. And I need to increase my activity, which should be easier once I get my knees replaced.

At any rate, I’ll try to keep an eye on my consumption and ask my husband to help me when it comes to eating better. Now that the holidays are almost over, it’s time to get back on track. Losing another 18 pounds sure wouldn’t do me any harm.